Being Mortal: Medicine and What Matters in the End by Atul Gawande

When I heard about the subject matter for this book, I did not want to read it. I am  almost 63 years old and I have a mother who is 90 years old. So this book strikes home… My father died when I was seven, I have lost my sister, cousins and other family members. I have seen what happens when people die from cancer. So while I read many of the tragic stories of how people died in this book, it does not come as a great surprise to me. What I take from this book is that we all should have options on how to end our life when there is so much pain, no hope…

Listed below are my takeaways from excerpts in the book:

Modern scientific capability has profoundly altered the course of human life. People live longer and better than any other time in history. But scientific advances have turned the processes of aging and dying into medical experiences, matters to be managed by healthcare professionals. And we in the medical world have proved alarmingly unprepared for it.

This experiment of making mortality a medical experiences is just decades-old. It is young. And the evidence is it is failing.

This is a book about the modern experience of mortality – about what it's like to be creatures who age and die, how medicine has changed the experience and how it hasn't, how our ideas about how to deal with our finitude have got the reality wrong.

The waning days of our lives are given over to treatments that battle our brains and sap our bodies for a sliver's chance of benefit.  They are spent in institutions – nursing homes and intense care units – where regimented, anonymous routines cut us off from all things that matter to us in life.

Old age is not a diagnosis. There is always some final proximate cause that gets written down on the death certificate – respiratory failure, cardiac arrest. But in truth, no single disease leads to the end; the culprit is just the accumulated crumbling of one's bodily systems while medicine carries out its maintenance measures and patch jobs.

Researchers found that loss of bone density may even be an even better predictor of death from atherosclerotic disease than cholesterol levels. As we age, it’s as if the calcium seeps out of our skeletons and into our tissues.

Medicine has been slow to confront the very changes that it has been responsible for – or to apply the knowledge we have about how to make old age better. Although the elderly population is growing rapidly, the number of certified geriatricians the medical profession has put in practice has actually fallen in the United States by 25% between 1996 and 2010.

Whenever serious sickness or injury strikes and your body or mind breaks down, the vital questions are the same: What is your understanding of the situation and its potential outcomes? What are your fears and what are your hopes? What are the trade-offs you are willing to make and not willing to make? And what is the course of action that best serves this understanding?

Certainly, suffering at the end of life is sometimes unavoidable and unbearable, and helping people and their misery may be necessary. Given the opportunity, I would support laws to provide these kinds of prescriptions to people. About half don’t even use their prescription. They are reassured just to note they have control if they need it.

Funniest Thing I Read Today (Top 10 List on Ted Cruz)

From the David Letterman show...

Top Ten Little Known Facts About Ted Cruz

10. Was never elected to congress, just started showing up

9. Loves his home country, and America

8. Not Mormon but still wears special underpants

7. Vows to stay in the race until offered a spot on "Dancing With The Stars"

6. Filibusters in his sleep

5. 'Ted' is short for 'Tedium'

4. Uses teeth-whitening strips and hair-blackening strips

3. Already planning 2020 failed presidential bid

2. His wife affectionately refers to him as 'Ted Cruz'

1. Has just as good a chance of winning the Democratic party's nomination

Smartest Thing I Read Today: Middle East Politics

From Tom Friedman's NY Times Column "Go Ahead, Ruin My Day"

We’re talking about our choices in these countries with words that strike me as about 10 years out of date. Alas, we are not dealing anymore with your grandfather’s Israel, your father’s Iran or the Iraq your son or daughter went off to liberate.

It is hard to know what is more depressing: that Netanyahu went for the gutter in the last few days in order to salvage his campaign — renouncing his own commitment to a two-state solution with the Palestinians and race-baiting Israeli Jews to get out and vote because, he said, too many Israeli Arabs were going to the polls —  or the fact that this seemed to work.

In the brutal Middle East, the only thing that gets anyone’s attention is the threat of regime-toppling force. Obama has no such leverage on Iran.

Why are we, for the third time since 9/11, fighting a war on behalf of Iran? In 2002, we destroyed Iran’s main Sunni foe in Afghanistan (the Taliban regime). In 2003, we destroyed Iran’s main Sunni foe in the Arab world (Saddam Hussein).

Zero to One: Notes On Startups, Or How To Build The Future by Peter Thiel

I loved this book as it was full of new and creative thinking and ideas. I also think the ideas are very valid, for this economy and for this generation. This book should be required reading for all business students or people considering the start of a new business.

Shown below are my bulleted takeaways from this book:

• Every time we create something new, we go from 0 to 1

• Unless they invest in the difficult task of creating new things, American companies will fail in the future the matter how big their profits remain today.

• Zero to One is about how to build companies that create new things.

• Progress can take one of two forms. Horizontal or extensive progress means copying things that work going from 1 to n. Vertical or intensive process means doing new things going from 0 to 1.

• Our educational system both drives and reflects our obsession with competition. Grades themselves allow precise measurements of each student's competitiveness; pupils with the highest marks receive status and credentials. We teach every young person the same subjects in mostly the same ways, irrespective of individual talents and preferences. 

• For Hamlet, greatness means willingness to fight for reasons as thin as an egg shell: anyone would fight for things that matter; true heroes take their personal honor so seriously they will fight for things that don't matter. This twisted logic is part of human nature, but it's disastrous in business.

• Simply stated, the value of a business today is the sum of all the money it will make in the future. To properly evaluate business, you also have to discount those future cash flows to their present worth, since a given amount of money today is worth more than the same amount in the future.

• Comparing discounted cash flows shows the difference between low growth businesses and high-growth startups at its starkest. Most of the value of low growth businesses is in the near-term. Technology companies follow the opposite trajectory they often lose money for the first five years: it takes time to build valuable things and that means delayed revenue. Most of a tech company's value will come at least 10to 15 years in the future.

• Bankers make money by rearranging the capital structures of already existing companies. Lawyers resolve disputes over old things are help other people structure their affairs, and private equity investors and management consultants don't start new businesses; they squeeze extra efficiency from old ones with incessant procedural optimizations. It's no surprise that these fields attract all this portion the numbers of high achieving Ivy Leaguers optionality chasers; what could be a more rewarding for two decades of resume building them a seemingly elite process oriented career that promises to “keep options open”?

• We are more fascinated today by statistical predictions of what the country will be thinking in a few weeks time then by visionary predictions of what the country will look like 10 or 20 years from now.

• US companies are letting cash pile up on their balance sheets without investing in new projects because they don't have any concrete plans for the future.

• The greatest thing (Steve) Jobs designed was his business. Apple imagined and executed definite multiyear plans to create new products and distribute them effectively. Forget “minimum viable products" – ever since he started Apple 1976, Jobs saw that you can change the world through careful planning, not by listening to focus group feedbacks or copying others' successes.

• A startup is the largest endeavor over which you can have definite mastery. You can have agency not just over your own life, but over a small and important part of the world. It begins by rejecting the unjust tyranny of Chance.  You are not a lottery ticket.

• Every university believes in "excellence" and hundred page course catalogs arranged alphabetically according to arbitrary departments of knowledge seem designed to reassure you that 'it doesn't matter what you do, as long as you do it well'. That is completely false. It does matter what you do. You should focus relentlessly on something you're good at doing, but before that, you must think hard about whether it will be valuable in the future.

A Brief Profile of Me

What I'm Reading Now:  Zero to One: Notes on Startups, or How To Build the Future by Peter Thiel

 On My Night Stand: Dead Week: The Last Crossing of the Lusitania by Erik Larson and  All The Old Knives by: Olen Steinhauer

 Favorite Books When  I Was a Kid:   Hardy Boys, Tom Swift, Chip Hilton and Rick Brant series

Number of Books I've Read  Lifetime: 5,500 books or about 100+ books a years (est.)

 Favorite News Websites: Huffington Post, New York Times

Favorite Business Website: Seth Godin's Blog (  He writes a post every day and I read his post every day.)

 E-book or Paper?  My preference is to read a hardcover or paperback book.  Part of the reason is that I'd like to highlight or make notes within a book.  One can do this in an e-book but not very easily.

Current Magazine Subscriptions: None

Past Magazine Subscriptions: Runners World, Men's Health, Playboy ( a long time ago), U.S.  News and World Report

Literary Tastes:

•  I may read one fiction book to every eight or nine nonfiction books.
•  I rarely read fiction books authored by a woman.  I have no prejudice against nonfiction women authors.
• Unfortunately I read or skim books too quickly. I also pull the trigger within the first 20 or 30 pages if a book does not interest me.

More Gems from Seth Godin on Customer Service

I am a huge Seth Godin fan. Just about every blog post he publishes could be included in my " smartest things I've read today."  This blog post covers customer service issues.

 Some ways to make people feel stupid:

• Change different prices at different outlets and shrug your shoulders when you get found out.
• Give new customers a great discount for signing up, but tell  long-term customers that they're out of luck. ( EB comment:  that's for you Comcast)
• Sell the private data you get from customers to other marketers without asking them first. (EB comment:  that's why I have issues with making charitable donations. Your name and phone number gets sold to other  charities who begin to solicit you.)
• Put the important information in your terms and conditions, in little tiny type
• Lower your pricing but don't honor it for people who just bought from you.